Gastric Volvulus

Gastric volvulus is a condition involving the stomach twisting upon itself.

The twist may be a flip over of one side on the other, along the axis of the two ends of the stomach, called organoaxial volvulus (more common variant), or may be a flip of the upper part of the stomach on the end of stomach, called mesenteroaxial volvulus (less common).

A combination of both types may occur in an individual.

Volvulus of the stomach is very rare.

It can occur at any age. It is commoner in adults. Childhood gastric volvulus account for up to 20% of stomach volvulus, and more than half of these occurs before the first one year of life.

Males and females are equally affected.

Causes of Gastric Volvulus

Volvulus of the stomach is more common in individuals with birth defects (congenital abnormalities) of their diaphragm; hiatus hernia; too long gastric (stomach) ligaments; no spleen; weak muscles (motor neurone diseases); tumour of the stomach or other defects affecting the stomach.

Those with defects of the diaphragm commonly suffer with the common type (organoaxial volvulus), and it is the most serious form, needing urgent surgical intervention.

The mesenteroaxial type does not often lead to compromise of blood supply to the stomach speedily, and may run a chronic course.

How does Stomach Volvulus Present

Gastric volvulus presents classically with severe abdominal pain, mainly in the central upper abdomen (epigastrium), retching without vomiting, and inability to pass a tube from the nose down to the stomach by doctors in the hospital.

The pain usually come on suddenly from the blues, severe, and may easily be confused with a heart attack. If not relieved on time, patient may start vomiting blood due to break down of the wall of the stomach.

In those with the chronic type, the pain would be less severe, occurring over a long time, with the patient getting filled easily after eating very small amount of food.

Diagnosis of Gastric Volvulus

The diagnosis of gastric volvulus can be suspected from the history if it fits the classic triad described by Moritz Borchardt (1868 – 1948), as Epigastric pain, retching without vomiting, and inability to pass a naso-gastric tube.

To confirm the diagnosis, any of the following could be done:

X-RAY

This will show gastric volvulus as a air-filled sac behind the heart shadow on a chest x-ray, described as a re-cardiac air bubble, or fluid filled sac.

X-ray of the abdomen may show part of the stomach that may still be in the abdomen, massively distended.

BARIUM MEAL

A barium meal is a special type of x-ray where a toothpaste-like gel is given to be showed and swallowed, to provide contrast, after which a routine x-ray is taken.

In this condition, a barium meal will show narrowing or absence of barium in the part of the stomach where the obstruction is.

CT-SCAN

A computed tomography scan, commonly called CT-scan will show the whole anatomy of the stomach, making precise diagnosis possible, as well as the type of obstruction.

It may also give clue as to the cause of the gastric volvulus in the first place.

Treatment

Acute gastric volvulus is a surgical emergency. Once the diagnosis is suspected and confirmed, attempt to relieve the obstruction by means of Endoscopic manoeuvre may be attempted.

This may be achieved by introducing the endoscope beyond the point of obstruction and then rotated to unwind the twisted stomach.

There is a high risk of perforation, especially if the obstruction has been on for a long time.

Any seeming delay, Endoscopic manoeuvre must be abandoned immediately for open surgery.

Once the abdomen is opened, the stomach is identified, untwisted, and it’s viability tested. If still viable, the stomach is secured by fixing it to the anterior abdominal wall and diaphragm (called anterior gastroplexy).

Any defect in the wall of the diaphragm that may have in the first place been the cause of the volvulus is repaired.

After the operation, you will be moved over to the recovery room. You may wake up to find many tubes connected to you. A tube may be in your nose, draining fluid (which may be blood stained), from your stomach. Other tubes may be coming from your bladder, and drips in your veins.

You may have sticky bits with wires on your chest to monitor your heart and blood pressure cuff on your arm. Do not panic.

After a while, you will be moved over to the ward once the anaesthetic agent has worn off from your system. You may be in hospital for a couple of days, and then be discharged.

Stitches may come out on the seventh day. If dissolvable stitches were used, you need not worry about removing stitches.

When Can I Drive After Surgical Operation

After such a major operation, you need at least two to six weeks to recover. You can then think of driving after this period.

You can call your G.P or family doctor to advice you or better still, contact your car insurance company for specific advice.

As a general rule, once you fill strong enough and you can make emergency stops without any pain at the operation site or any other where for that matter, then you are on your way to driving after an operation.

When Can I have Sex after Surgery

When to have sex after a surgical operation has no hard and fast rule, except specifically stated by your treating physician.

The general guide would be after the first 2-6 weeks, or when you will not be putting the area operated under lots of stretch and stress.

If you find it difficult to stay away from sex for that long, you can play a less active role during intercourse, causing you less strain and pain.

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